ESPE Abstracts

Introduction: Graves’ disease (GD), the main cause of hyperthyroidism in children, is caused by thyrotropin receptor stimulating autoantibodies (TRABs) that activate thyroid hormone synthesis, secretion and thyroid growth. Therapeutic options are anti-thyroid drugs (ATD), 131-I or thyroidectomy. This study reports the experience of a Tertiary Pediatric Endocrinology Unit.

Methods: Review of GD patients diagnosed from January/2001 to October/2017. Results were expressed as mean and standard-deviation, statistical significance at <0.05.

Results: 21 patients, 19 girls, 38% diagnosed in the last two years. At diagnosis, mean age was 11.94±3.50 years, 6 patients (28.6%) presented ophthalmopathy, FT4 and FT3 levels were increased 7.70-fold (0–35) and 2.13-fold (0–5.7); mean TRABs titer was 27.54-fold (0–188) and normal in 2 patients. All patients had thyroid volumes above 97th percentile. Five patients (23.8%) presented thyroid disease family history and 3 (14.3%) had other auto-immune disease. All patients received ATD as first treatment: 23.8% (n=5) propylthiouracil (PTU) (before 2011), 71.4% (n=15) tiamazol (TMZ) and 1 carbimazole. Mean time treatment since diagnosis until TSH normalization was higher for PTU (6.5±0.71 (6–7); 4.39±2.94 months (0.81–10.0) – P=0.049). Time to thyroid hormones normalization was similar for both drugs (PTU 3±1.4 (2–4); TMZ 3.28±2.99 months (0.4–10) – P=0.844). Both ATD had similar TRAbs titers when thyroid function normalized (P=0.199). No adverse effects were reported with TMZ. One PTU treated patient developed hepatitis. Mean treatment duration was: PTU 40.60±35.54 and TMZ 28.90±13.20 months, P=0.282; remission rate was 19%, similar for both ATD (P=0.217). After TSH normalization, ATD maintenance mean time was: PTU 20.5±2.1 and TMZ 24.51±14 months, P=0.323. A 2^nd treatment was tried in 3 patients; 2 relapsed and were proposed for definitive treatment. Definitive treatment was used in 8 patients (38%), 131-I in 6 (28.6%), with no adverse reactions, and surgery (total/subtotal thyroidectomy) in 2 (9.5%). One patient needed a second 131-I dose. After surgery, 1 patient developed persistent hypoparathyroidism. Seven patients (33.3%) maintain ATD treatment (mean time 22.94±9.0 (14–36) months); 2 finished ATD 2 months ago.

Conclusions: As recommended by 2011 international guidelines, TMZ was the first treatment. Despite a rapid achievement of euthyroidism, treatment duration was longer and only 19% patients entered remission. We found an increase in diagnosis in the last years that conditioned our results. Definitive therapy had a high rate of success without adverse effects.